1980, 12-17 Permit: 80B-4987 Plumbing Fixtures PLAN NUMBER APPLICATION/PERMIT p PERMIT NUMBER 1
SPOKANE COUNTY — BUILDING CODES DEPARTMENT g1.3 --4W7
I NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE --17—k0
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS L. J* 1 l 11 U
1. 6 c-7/7 94k LEGAL DESCRIPTION — SEE ATTACHED , l., 4
LOT BLOCK SUBDIVISION PARCEL NUMBER/S
2. * 10 .00
OWNER PHONE f; *
3. PAu(c c-lcS 9.14.2- 02.78 r,
A DRESSZIP Required Set Backs in Feet C, 9
r' 17
4C mc„� U bin, North 'South East (West 1 r_- 1 7— r
CONTRACTOR PHONE Size of Parcel Zone Classification
172.o s ViAe t Q -8srg f ti
4' ADDRESS ZIP Type Const. Occupancy Sprinklered
Oyes ❑No ❑ Req'd.
DESIGNER PHONE Valuation Building Area in Sq. Ft.
5. ADDRESS ZIP DWL Area Basement Area Garage Area Storage --
CHANGE OF USE FROM TO Split Entry Split Level Rancher
6.
CZ
No.Baths No. Floors No. Rooms Rec. Room
TYPE
L!1 NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF // ElOTHER
WORK ❑ BLD. ��," LMB. ❑ MECH: ❑ M.H. ❑ POOL CERTIFICATE Req'd. Rec'd. Not Req'd.
of EXEMPTION
DESCRIBE WORK
8. n- FEES COLLECTED
VALUATION Source GAS ELECTRIC WATER SEWER
of
9. Utilities
Single $
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this Building
type of work will be complied with whether specified herein or not. The granting of a permit does not presume
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the 1000
performance of construction. Plumbing
DATE 19t S- 97 SIGNATURE M'` Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D. ^ Plan Check
Env.Health 1(15-6,11 new 44 2.S0
,•, n
. W.G• h.S0 SEPA O
Planning ` w
hta-tee. So
Mobile Home
Fire Marshall
—
Co. Engineer 00 Other(Specify)
Utilities ., 4 10 . -
TOTAL $ 1000
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist C� . kn THIS BECOMES A PERMIT. /) (� Q '7
DAT /7—Ov OFFICIAL-4e41 �'/,L' '�L' 12 I7 8 49 Q / 2 * 1QO0dF-
APPROVED FOR ISSUANCE 1